Hospital Food High in Salt

Action Points

The objectives of this study were to quantify the amount of sodium in commonly prescribed hospital patient menus and to determine whether these levels are in agreement with established sodium recommendations.

Among a sample of standard hospital menus in which patients did not pick their own meal choices, 100% exceeded the adequate daily intake of 1,500 mg of sodium, and 86% surpassed the maximum recommended levels of 2,300 mg, JoAnne Arcand, PhD, RD, of the University of Toronto, and colleagues reported in a letter online in the Archives of Internal Medicine.

Currently, the Institute of Medicine recommends 2,300 mg a day for healthy patients but 1,500 mg a day for certain higher risk groups. But much of the focus on salt reduction has been on consumer food services, rather than food served to hospital patients.

So to assess the amount of sodium in hospital menus, the researchers looked at the contents of several types of menus from three acute care hospitals in Ontario:

84 menus in which patients don't select their own items

633 regular menus in which patients can pick their own food

628 menus for diabetics picking their own food

630 patient-selection menus for those on 3,000-mg sodium daily diets

343 patient-selection menus for those on 2,000-mg sodium a day

They found that the mean sodium level in the standard menus in which patients don't choose their own meals was 2,896 mg.

All of these menus exceeded the acceptable intake levels of 1,500 mg and 86% exceeded upper-level limit of 2,300 mg, the researchers reported.

When patients could choose their own items, 97% of the menus exceeded acceptable intake and 79% exceeded the upper-level limits, they found.

For diabetics who didn't choose their own items, the mean sodium level for their menu was 3,406 mg, and all of these menus exceeded both the acceptable and upper limits of sodium intake.

Sodium levels were similar when diabetics chose their own food, and 99% exceeded the 1,500 mg limit while 95% exceeded the 2,300 mg level.

For patients on salt-restricted diets, both the standard menus and the patient-selected menus contained similar levels of sodium, with the majority falling within prescribed levels, the researchers wrote.

But for patients on a 2,000-mg diet, mean sodium levels were significantly higher when patients chose their own items, compared with the standard pre-selected menus (2,041 mg versus 1,504 mg, P<0.001).

Almost half of the patient-selected menus for the 2,000-mg diet exceeded the prescribed levels, and were significantly more likely to do so than the pre-selected menus (47% versus 10%, P<0.001).

"This observation could have important clinical implications given the therapeutic necessity of sodium restriction in conditions such as decompensated heart failure," they wrote.

Arcand and colleagues said their findings are evidence that hospitals are "increasingly serving prepared foods rather than preparing foods from unprocessed ingredients."

This is cause for concern, they wrote, because most of these patients are "nutritionally vulnerable" or have cardiovascular diagnoses "for which sodium intake regulation is essential."

Kirsten Bibbins-Domingo, PhD, MD, of the University of California San Francisco, wrote in a commentary that the study "adds to the growing evidence of unhealthy food environments in our healthcare institutions."

Bibbins-Domingo said hospitals have an opportunity similar to when they banned smoking on their premises decades ago: "Hospitals again have the opportunity to take the lead and to create food environments that are consistent with their mission to cure the sick and promote health."

Neither the researchers nor the editorialists reported any conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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